About Your Goals & Needs

First Name

Last Name

Email *

Phone *

Address

Street Address

City

State

Country

Postal code

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What are your primary dietary goals? (Select all that apply)

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Weight loss

Improved energy levels

Managing a specific health condition (e.g., diabetes, allergies)

Learning healthier eating habits

Other (please specify)

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How much time per week are you realistically able to dedicate to exercise?

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Less than 2 hours

2-4 hours

4-6 hours

6+ hours

What is your preferred style of exercise? (Select all that apply)

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Strength training (weights, bodyweight)

Cardio (running, cycling, swimming)

Flexibility/mobility (yoga, Pilates)

High-intensity interval training (HIIT)

Other (please specify)

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Do you have any dietary restrictions or preferences? (Select all that apply)

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How often would you prefer to receive check-ins or support from your coach?

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Daily

A few times a week

Weekly

As needed

What level of guidance and support are you looking for?

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Detailed, structured plans

General guidance and accountability

Just need workout routines

Just need meal plans

Are you interested in tracking your progress (e.g., weight, measurements, food intake)

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Yes, definitely

Maybe

No, not really

What is your budget range for a fitness and diet coach?

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Which of the following qualities are most important to you in a fitness and diet coach? (Select up to three)

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Are you looking for a coach with experience in any specific areas? (e.g., pre/postnatal fitness, sports nutrition, managing chronic conditions)

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Yes (please specify)

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What are your biggest challenges when it comes to achieving your fitness and diet goals?

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What would make your coaching experience successful?

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Is there anything else you would like to share about your needs or preferences for a fitness and diet coach?

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